Ketones!

I wrote recently that my Endo instructed me to eat a snack around 2 or 3 in the morning in an attempt to eliminate the ketones I have been observing first thing in the morning.

I was not happy about this early morning chore, but I am just trying to kep my eye on the prize: a healthy baby. I’ve been eating the snack all week and so far my ketones in the morning have dropped to negative or trace, so the snack seems to be working.

But then I got to wondering … what is the big deal with a couple of ketones, anyway? Just because I am burning a little fat overnight instead of sugar, as long as my BGs are good, what’s the problem? I mean, I started this journey in the overweight category, so it is not like I am wasting away to nothing here. There is plenty of nourishment in the form of fat to be had for my growing baby.

So I started researching. Naturally, Google was my first stop. I found surprisingly little about ketones short of a couple of very generic explanations of what ketones are and why we spill them. This article by Joslin, in particular, has a good basic explanation.

As a refresher, when the body burns fat for fuel, ketones are produced and “spilled” in the urine. For us diabetics, this usually happens when we do not have enough insulin in our systems to convert the sugar in our blood to energy. Instead we burn fat and spill both the ketones and the sugar in our urine.

This was not news to me. And because my blood sugars were good, the ketones were apparently due to a shortage of energy stores. That is, my baby was using up all of my excess energy stores and then some. As a result, my body was burning fat to keep up.

What I really wanted to know, though, was how these ketones are affecting my baby? Sadly, there just does not seem to be much out there. The best I could find is this account from a mother who had gestational diabetes during pregnancy. She calls herself Kmom, and the piece is well-written and seems to be well-researched.

She references two studies that showed a correlation between increased ketones and decreased IQ in the baby. However, she also points to further studies that reviewed the first two and were not able to confirm their findings. She pulls an excellent quote from the Journal of American College of Nutrition, which I requote here:

Even if the ketonuria in GDM were associated with lower IQ in offspring, it seems more likely that the overall poorer diabetic control resulting in ketonemia is more responsible for the lower IQ than an effect of ketone bodies per se…In any case, there is no consistent epidemiologic link between maternal ketonuria per se and impaired fetal growth and development.

That information eases my mind a bit, because I know that I am generally under good diabetic control. But I am still a little concerned.

Kmom says, “To prevent ketones in general, you should be eating every 3-4 hours in pregnancy, so that your body has a constant supply of energy and never needs to access the fat stores.”

Her reasoning seems sound and fits with the rules I remember learning back in my ADA diet days as a kid. And it made me realize that I am probably not eating often enough. In fact, after lunch at noon I often don’t eat until dinner around 7 pm or so. Last night before dinner I tested for ketones and found that I was spilling LARGE ketones. Not just trace, small, or even medium amounts, but LARGE. I was frantic. How long has this been going on??

So my new resolution is to eat at least every four hours and to try to include protein and carbs in every meal or snack.

This is not going to be easy. I have already upped my caloric intake thanks to an extra mini-breakfast as soon as I wake up and that 2 am snack, so I am simply not hungry most of the time. My stomach feels full pretty much constantly.

I am also a little aggravated that none of my doctors have bothered to explain all of this to me. When I was just in my 6th week or so, I asked my Endo for a referral to a dietician and he hedged, stating that the local dietitians would not be very helpful for someone who has had diabetes as long as I have. But I knew that my diet was less than healthy and I wanted some tips for ensuring that my baby was receiving adequate nutrition and energy.

Now that I know about this whole ketone thing, I am even more concerned. What other nutritional requirements am I missing? I see the high-risk OB this week. Maybe he knows a dietician who can help me get my head around eating right for my baby.﻿

Nici, I’m 35 weeks pregnant and a type 1 for twenty years now. I spilled dark dark purple (supersized) ketones one night during week 28ish and everyone in my medical team had different theories about it.

The OB said it was likely dehydration (which is possible – I hadn’t had much to drink that day). The on call nurse at my endo’s office thought it was what you’re talking about – “starvation ketosis” because I ate a sandwich for lunch around 11:30 and started spilling ketones around 3pm and into the evening until dinner. My CDE/nutritionist said she thought it was bad insulin or a pump malfunction and had me change everything out with a new vial of insulin. But, in the end, my endo said that the truth is that they don’t know exactly why we are more prone to have ketones during pregnancy, but that there seems to be no threat to the baby. Only to the diabetic. She thought that dehydration sounded the most plausible in my case though.

Reading up on placental hormones (specifically the anti-insulin hormone “human placental lactogen”) on Wikipedia, I did read that the placenta tries to compensate for possible malnutrition in the mother. In women who are not well nourished, the ketones can actually provide the baby with energy. So maybe that has something to do with it.

I’m as curious as you are…and glad that increasing my fluids and eating more often has prevented any other serious ketone events.

Thanks for sharing this story! I am 30 weeks along and just diagnosed with gestational diabetes. This is my first baby and all this ketone business has me worried. It sounds like you got everything under control. I am curious, how is your baby? I hope all is well!

I’m glad you’re finding my story helpful. Lukas is perfectly healthy. We have not seen any indications that the ketones caused him any harm. I don’t seem to have suffered any ill effects, either. The biggest “problem” we have since he was born is not having time to write blog posts 🙂

Thanks for sharing this information. You’re right, it is difficult to find information out there concerning effects of ketones on the fetus and it’s really frustrating to have just found enough to worry about it and for the doctors not to know how to advise.

I’ve been a bit beside myself b/c I was diagnosed with GD at 28 weeks, currently 35 weeks and have had very good BG levels but my ketones fluctuate from trace to moderate (more often they are mod.). I’ve been very careful -walking after 2 meals a day and sometimes eating fewer carb. servings than the dietitian recommends to keep my numbers consistent. I want to have a home birth and they require near perfect numbers- but I’m having a hard time striking a balance. I’ve been reading about the findings of low IQ and it has me quite worried. It makes sense that – roughly- oxygen levels would be effected by high acidity in the bloodstream -but I appreciate you posting this with a link to the other GD Mom’s info so, hopefully, I can find some more research. Meantime- I’ll be drinking as much water as I can to flush this stuff out!

For Mom’s out there looking at this- here is one of the articles I found- hopefully since it’s 2005 publication, the research sited above is more up to date and will negate it!